Psychosis and Work

“Is it catching?” asked a member of staff at music therapy charity Key Changesafter several months of working with people diagnosed with psychosis.

“Of course psychosis isn’t catching,” says Pete Leigh, founder of the charity, “but those of us working in such environments have to look after ourselves and each other to avoid being deeply affected.”

Staff at Key Changes mentor young people with severe mental health problems through music sessions and spend many hours every week working on psychiatric wards. As is often the case for those in the helping professions, if left unchecked this work can have a deep impact on staff’s own disposition and wellbeing.

The risk of burnout

Those holding such roles are often left unaware of the serious impact their job can potentially have on their mental health until the effects of vicarious traumatisation – also known as burnout or compassion fatigue – start to show years later.

A poll by mental health charity Mind last year found that 87% of emergency services staff and volunteers had suffered from stress, low mood and poor mental health at some point while doing their job.

Yorkshire paramedic Neil Hemingway is one of them and believes more discussion about the effects of such work is vital to combat the rise in mental health problems among emergency services personnel.

Seeking help

“I was diagnosed with depression 15 or 16 years ago,” says Hemingway. “I went through counselling and thought everything was sorted. Then, just over three years ago, my personality began to change dramatically. I was moody, I was down. I was being woken up by my dreams two or three times a night and I was having flashbacks throughout the day.” With strong support from a concerned colleague, Hemingway eventually spoke to his manager and saw a counsellor and mental health specialist. Hemingway discovered his problems were related to post-traumatic stress disorder (similar in nature to vicarious trauma) and received eye movement desensitisation and reprocessing treatment.

He says the high pressure of the role leaves paramedics with little time to have honest discussions about their mental health with their colleagues, while some don’t wish to be perceived as weak.

“There is still a strong stigma around mental health (in his profession), but my aim is to make conversations about mental wellbeing commonplace.”

The importance of talking

In order to avoid burn out, psychotherapist Sandra Grieve says regular debriefing and discussion is vital.

“Psychotherapists are required to have our own counselling where we can discuss and deal with things that have come up; a lot of professions in this space don’t have that,” she says. “It’s so important because being involved in difficult or sad situations can be like going through them ourselves. The mirror neurons in our brain mean that when we witness something it has a similar affect on us to actually experiencing it. I have psychiatric nurses who come to me and pay for sessions themselves because their employer doesn’t offer this service and they need to discuss things. Not working through thoughts and feelings will often lead to physical illness otherwise.”

NHS staff sickness absence caused by mental ill-health has more than doubled to 40,000 since 2010, according to figures obtained by the Observer earlier this year. A similar picture seems to be painted across the board.

Nushra Mansuri, professional officer at the British Association of Social Workers, says there’s a lack of support in the social work sector.

“There is a lack of knowledge about vicarious trauma,” she tells the Guardian. “Reports such as those by Eileen Munro and Lord Laming have found that we are remiss in looking after those who are dealing with extreme material such as suicide and child abuse. You will get good individual line managers who will go the extra mile [to help], but there’s not a strong culture of it and social work is suffering huge burnout; we can’t afford to lose any more staff.”

Turning to meditation

There are different types of therapy on offer for those who suffer vicarious traumatisation, including cognitive behavioural therapy (CBT). Some people working with those in helping professions say the benefits of meditation, for caring staff in particular, should not be underestimated.

“Empathetic people – who often find themselves in the caring professions – can feel the pain of others very deeply and can find themselves switching off their feelings as self-protection,” says Darran Trute, partnership manager at Awareness in Action.

His organisation works with frontline staff to teach them meditation, in particular the meditation known as Metta or loving kindness. “This can create new neural pathways that regulate pain and nourish the meditator so that difficult situations are much less likely to overwhelm,” he says.

Maureen Cooper, founder of Awareness in Action, adds: “Vulnerability comes more when we are attached to the idea of helping others and see ourselves as having a duty, or mission to be of benefit – rather than it being a natural expression of being human. This kind of effort, and identification with being ‘helpful’, is in itself a cause of stress and potential burnout.”

Dealing with people in “constantly desperate situations” as a debt case worker for Citizens Advice Bureau left Andy Wallace feeling burned out. As a result, he turned to loving-kindness meditation, which he’s now been practising for the last six years. Wallace says he has been “genuinely surprised” by how much it’s helped him. “I used to be irritable and found my work very intense,” he says. “Since I discovered it, I’m a different person.”

Meditation is just one of a range of measures for protection against vicarious trauma suggested by Laurie Anne Pearlman, a clinical psychologist and author of several books on the subject. She has a checklist (covered in detail by the Headington Institute where Pearlman works), around how to ensure a person stays as resilient as possible to vicarious traumatisation. It includes having a balanced, meaningful life, connecting with ourselves and others, exercising, getting support in life and work, and practising gratitude.

She warns that self-medicating with the likes of food, alcohol, shopping, the internet and exercise can be signs that the helper has a problem.

Creating a support network

In order to combat potential vicarious trauma, Pearlman says staff need to be involved in decisions affecting them and have flexibility where possible. She also advises that such professionals also need to receive clinical consultation separate from administrative supervision, and access to mental health services.

Without this network of support, Pearlman says staff can become less tolerant, less understanding, less able to regulate their feelings, dispirited and dissociated, and they will be less able to enjoy fulfilling work or personal life.

While some people can overcome vicarious trauma by following these guidelines, she says it has to be acknowledged that sometimes people will need to take a break, or leave their workplace or profession completely.

If staff do want to return to work at some point, they must find a new way of working, she says. “They will need to develop a personal plan [with their employer] that will allow them to do the work with emotional openness while maintaining boundaries, getting more support and having a fulfilling personal life.”